Treatments and drugs

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Some people with essential tremor may not require treatment if their symptoms are mild. But if your essential tremor is making it difficult to work or perform daily activities, you may want to discuss treatment options with your doctor.

Medications

Beta blockers. Normally used to treat high blood pressure, beta blockers such as propranolol (Inderal) help relieve tremors in some people. Other beta blockers that may be used include atenolol (Tenormin), metoprolol (Lopressor), nadolol and sotalol (Betapace).

Beta blockers may not be an option if you have asthma or certain heart problems. Side effects may include fatigue, lightheadedness or heart problems.

Anti-seizure medications. Epilepsy drugs, such as primidone (Mysoline), may be effective in people who don't respond to beta blockers. Other medications that may be prescribed include gabapentin (Neurontin) and topiramate (Topamax). Side effects include drowsiness and nausea, which usually disappear within a short time.

Tranquilizers. Doctors may use drugs such as alprazolam (Xanax) and clonazepam (Klonopin) to treat people whose tremors are made worse by tension or anxiety. Side effects can include fatigue or mild sedation. These medications should be used with caution because they can be habit-forming.

OnabotulinumtoxinA (Botox) injections. Botox injections may be useful in treating some types of tremors, especially head and voice tremors. Botox injections can improve tremors for up to three months at a time.

However, if Botox is used to treat hand tremors, it can cause weakness in your fingers. If it's used to treat voice tremors, it can cause a hoarse voice and difficulty swallowing.

Therapy

Doctors may suggest you participate in physical or occupational therapy. Physical therapists may teach you exercises to improve your muscle strength, control and coordination.

Occupational therapists may help you to adapt to living with essential tremor. Therapists may suggest adaptive devices to reduce the effect of tremors on your daily activities, including:

Heavier glasses and utensils

Wrist weights

Wider, heavier writing tools, such as wide-grip pens

Surgery

A surgical procedure, deep brain stimulation, may be an option for people whose tremors are severely disabling and who don't respond to medications.

In deep brain stimulation, doctors insert a long, thin electrical probe into your thalamus, the portion of your brain that causes your tremors. A wire from the probe runs under your skin to a pacemaker-like device (neurostimulator) implanted in your chest. This device transmits painless electrical pulses to interrupt signals from your thalamus that may be causing your tremors.

Side effects of surgery may include problems with motor control or speech, problems with balance, headaches and weakness. Deep brain stimulation, however, is very effective for severe essential tremor. Side effects are rare and often go away after some time or adjustment of the device.

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